Diabetes Drugs Flashcards
Rapid Acting Insulin
Drugs:
- Lispro
- Aspart
- Onset <30 min
- Peak effect is 30-90min
- Duration of action is 3-5 hours
- PRN for hyperglycemia
- AC (before meal) according to sliding scale
Short Acting Insulin
Drugs:
- Regular
- IV insulin
- Onset = 30 min
- Peak effect is 2-5 hours
- Duration of action is 4-12 hours
- PRN for hyperglycemia
- AC (before meal) according to sliding scale
Intermediate Acting Insulin
Drugs:
- Isophane NPH
- Cloudy insulin
- Onset is 1-2 hours
- Peak is 4-12 hours
- Duration of action is <24 hours
- given BID
Long Acting Insulin
Drugs:
- Glargine: once daily at HS
- Detemir: once daily at HS or BID
- Onset is 1hr
- Peak –> glargine has no peak, detemir peaks at 6-8 hours
- Duration is 24 hours
Insulin Combinations
- 70/30 (NPH/regular)
- 50/50 (NPH/regular)
- 75/25 (lispro protamine/lispro)
Insulin (general)
MOA:
- Promote cellular uptake of glucose => low BG
- Convert glucose into glycogen => low BG
- Promote cellular uptake of potassium => low K+
Indications:
- All type I
- TIID after oral agents not able to control BG
- Acute stress (acute disease/surgeries/trauma for diabetic patients who normally do not need insulin)
- Gestational
- Acute exacerbation of DM (DKA, HHS)
- Hyperkalemia
Insulin Administration:
- Always administer SubQ (only regular insulin can be given IV when BG is really high)
- Syringe & multi-dose vial
- Insulin pen
- Insulin pump
- Should rotate the site of injection to avoid lipodystrophy
Storage:
- Insulin becomes ineffective after expiration
- Never put it in the freezer –> deactivates the protein
- Avoid exposure to direct sunlight or heat
- Premixed vials always in the refrigerator
Nursing:
- Educate to wear a medical alert bracelet
- Meal planning for the next 24 hours before administering insulin**
- Avoid hypoglycemia at the time of “onset” and “peak”
- Monitor for hyperglycemia at the end of “duration of action”**
- What to do with insulin dose if expecting NPO in the next 24 hours
Labs:
- serum glucose:
- point of care (finger prick) not appropriate with severe edema
- serum BG by laboratory (venous sample)
want to avoid hypoglycemia (<70)
Oral Diabetic Agents General
MOA:
- ↑ cell sensitivity to endogenous insulin
- ↑ insulin production
- ↑ incretin (secreted by small intestine) to ↑ insulin
- ↓ breakdown of glycogen (hepatic glucose production)
- ↓ breakdown of starches in GI
Contraindications:
- Type-1
- Many are pregnancy category C (use insulin instead during pregnancy)
Caution:
- Requires next 24 hrs meal planning
- Hepatic & renal impairment (use insulin instead)
Side effect
- Oral antidiabetics ↑ cardiac function & myocardial O2 demand
- Monitor for angina, dysrhythmias
Patient education
- Keep a log of BG with factors affecting (diet, infection, medication, activity)
Nursing:
Avoid ETOH:
- High carb content –> hyperglycemia
- Liver failure –> hypoglycemic effect
- Low PO intake –> malnutrition/hypoglycemia
- Interaction with oral agents (disulfiram-like reaction)
Goal:
- Keep fasting BG below 150 (normal <100) **
- Prevent hypoglycemia **
Glimepiride, Glipizide, Glyburide
Oral AntiDiabetic Agents
Side-effects:
- Hypoglycemia
- Aplastic anemia
- Weight gain
- Seizure
- Disulfiram-like reaction (avoid alcohol)
Contraindication:
- RF & liver failure
- Pregnancy & lactation
- Surgery & severe infection**
“Hogs Gain Weight Seasonally During Autumn”
Metformin
Oral AntiDiabetic Agent
Stop taking 48 hours prior & after IV contrast to avoid RF
Side effect:
- GI upset
- Diarrhea (BID with meals to decrease)
- Nausea
- Anorexia (contact provider if continues)
- Weight loss (contact provider if continues)
- Vitamin B12 & folic acid (B9) deficiency (poor absorption) provide supplements PRN
Contraindication:
- Severe infection
- Acute disorders (shock, hypoxia)
- Chronic alcohol abuse disorder
Formin sounds like formal so –> Can Grandma Dance At Nadia’s Wedding Bash?
IV Contrast, GI Upset, Diarrhea, Anorexia, Nausea, Weight Loss, Vitamin B9 & B12 decrease
Acarbose
Oral AntiDiabetic Agent
MOA:
- Blocks pancreatic amylase (prevents sucrose break down)
- Take with the 1st bite of a meal tid**
Side effect:
- Poor iron absorption => anemia (monitor H&H)
Contraindication:
- Inflammatory bowel disease (IBS, UC)
- Bowel ulceration/obstruction
- Sucrose (table sugar): dextrose (glucose) + fructose
- SAFETY Education: manage hypoglycemia with dextrose paste not table sugar (sucrose)
Dexter drives a red car 3x/day & drinks the blood of other people so they are anemic & he has gut issues.
Hypoglycemia Treatment
If patient is fully awake and can safely swallow:
- Apple juice (dissolved sugar in water)
- Sugar candy
- Recheck BG in 15 min, if <75 retreat
- Follow with some protein (peanut butter sandwich)
If patient is lethargic/drowsy (needing verbal or tactile stimulation to open eyes):
- Should NOT take anything by mouth (high risk of dysphagia & aspiration)
- 1 mg glucagon IM => stimulate liver to release glucose; onset of action: 10 min
- 25-50 ml of 50% dextrose in water (D50); assure patent IV site; onset of action: 1 min –> vesicant
